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Frist Will Not Help Health Care’s Ills

Frist Will Not Help Health Care’s Ills

Dec 27, 2002
Frist Will Not Help Health Care’s Ills
by Jamie Court & Frank Smith
 
This article appeared in the San Diego Union Tribune on December 26th: by Jamie Court and Frank Smith

Capitol Hill’s well-heeled lobbyists and political cognoscente have proclaimed that with a doctor in charge of the U.S. Senate, health-care reform is imminent. Unfortunately for the public, the doctor running the chamber, Sen. Bill Frist, typifies the GOP’s new health-care strategy: care most about the health of corporations that elect you.

If the public does not stop Frist and K Street’s hired guns, the gains of the patients’ rights movement will be erased and the freedoms of drug companies, HMOs and hospital chains will be expanded at the expense of patients.

A heart and lung surgeon, Frist sponsored legislation this year limiting legal liability for drug-maker Eli Lilly and other manufacturers of a mercury-based additive to vaccines that is linked to autism in children.

The provision drew outrage from parents of autistic children as special-interest pandering when it passed as part of the Homeland Security legislation just after the election. The corporate pork was the first payback for pharmaceutical companies’ heavy last-minute financing for key Republican Senate candidates that changed the balance of power in the Senate. The Washington Post also reported recently that Eli Lilly bought 5,000 all copies of Senator Frist’s recent book.

As head of the National Republican Senatorial Campaign, Frist raised more than $100 million for GOP senators’ election campaigns. It is in this fund-raising role that observers say Frist won his new post. In 2003, the debts to these donors, many from the medical-insurance complex, will come due. As Senate majority leader, Frist will have the power to schedule or not schedule votes on legislation, determine committee assignments and control all debate, absent a super majority against him. (Given these powers, it is little wonder there were few words of criticism about his election even from Senate Democrats.)

Frist’s ownership of and entanglement with one of America’s biggest corporate criminals, hospital chain Columbia/HCA, shows where his loyalty is and should have prevented him from leading the U.S. Senate. In total, the company, now called HCA, will pay more than $1.7 billion in civil and criminal penalties – the largest amount ever in a health-care fraud case.

Frist’s family founded the company, which the government prosecuted for massive billing fraud. USA Today reported that U.S. Senate disclosure statements show he owned as much as $25 million in company stock. His wife has more than $1 million in stock. Frist claims the money is in a blind trust, but when a trust is invested heavily in a company, rather than an industry, it is all too visible. Rep. Pete Stark, the senior Democrat on the Ways and Means health subcommittee, recently stated that the government’s HCA settlement may have understated the fraud and could benefit the Frist family greatly. If Frist was a patriot, he would have sold his HCA stock a long time ago.

In the Senate, Frist has used this influence to further HCA’s interests by successfully blocking a strong patients’ bill of rights, gridlocking a mandatory Medicare prescription drug benefit, and promoting arbitrary caps on legal recovery by innocent victims who sue negligent hospitals like HCA.

With the heart and lung surgeon in charge, a whole new set of “health care” issues are likely to make the Senate tick.

– Patients’ rights

Instead of expanding patients’ new rights to hold HMOs legally accountable for delaying or denying care, the Senate debate will now be about limiting the rights of innocent victims of medical delays and negligence to hold accountable doctors, hospitals and the HMOs they work for.

– Medicare prescription benefit

Rather than force price controls on a pharmaceutical industry that turned the tide for the GOP, the Senate will create a “voluntary” prescription drug program with insurers selling a new product to seniors with new profits.

– Universal coverage

Forget a national Medicare plan for everyone who needs affordable health coverage. The Senate will focus on Medical Savings Accounts (MSAs) which force the public, instead of insurers, to pay for their health care; bare-bones insurance policies that do not pay for drugs, hospitalization or maternity costs; and mandatory insurance laws that force people to buy an unaffordable, low-quality product.

Watch out, America. If the public does not lash out, health-care reform will be about new burdens on patients and new freedoms for industries.
Court and Smith are co-authors of “Making a Killing: HMOs and the Threat to Your Health” (Common Courage Press). Court is executive director of the Foundation for Taxpayer and Consumer Rights. Smith is a senior fellow at Civil Society Institute.

Uwe Reinhardt responds on Malaysia's single payer proposal

Capitalist Taiwan (the Republic of China) has had such a single-payer scheme since 1995. Malaysia may well be inspired by that system.

Oddly enough, the Communist Peoples Republic of China on the mainland has a basically capitalist health system with millions of uninsured, among them all children. Employed persons in urban settings are covered by a form of social insurance system, but not their children. There’s virtually no insurance coverage in rural areas. Finally, there’s not much of a safety net. Hospitals are not set up to give charity care. There’s no one to shift costs to.

Happy holidays,

Uwe Reinhardt

The Doctor as Dealmaker?

Lawmaker by day, good Samaritan by night, Sen. Bill Frist (R-Tenn.) is a wealthy doctor-turned-politician who occasionally attends art openings at his family-endowed museum-but prefers to spend his vacations visiting remote African villages to dispense lifesaving care.

It goes without saying that he pilots his own plane.

So Frist fits neatly into the melodramatic script of Trent Lott’s fall from power, cast as the new majority leader called on to rescue the party in a moment of peril. “He really shows the true compassionate conservatism,” says Sen. Kay Bailey Hutchison (R-Tex.).

But this plot twist raises a thorny question that only time will answer: Can those delicate surgeon’s fingers manage the backslapping, arm-twisting, hand-holding and pocket-picking that comprise the sometimes grubby backroom reality of a Senate leader’s life?

His supporters point to the bills Frist has co-sponsored with politicians as wily and seasoned as Sen. Edward M. Kennedy (D-Mass.), and to his acclaimed leadership of the National Republican Senatorial Committee, where he captained the recent campaign to regain the Senate majority.

They also acknowledge that Frist’s background-well-born, expensively educated and drawn to the notoriously independent life of the superstar surgeon-was not an obvious preparation for his new life of haggling and dealmaking. “There are a lot of key senators who don’t really think they need any leadership,” a Capitol Hill veteran said. “Leadership is not a problem in the Senate. Followership is.”

The expertise that has made Frist an effective force in health care legislation will become relevant in a smaller-though still important-segment of his life. The close working relationship he has forged with President Bush will be, at least initially, viewed with some suspicion by senators who resent the role the White House is perceived to have played in Lott’s demise. And the idealism that Frist says motivated him to run for the Senate in 1994 will be a difficult candle to keep burning when the winds of political expedience start gusting.

Frist spoke of the difficult balance between nitty-gritty politics and a Dr. Kildare idealism in a recent Boston Globe interview. “There is this tension between two forces I am engaged in, between raw political power versus . . . the real quest, the real drive for substantive issues.” It is a tension that will only grow.

William F. Frist, 50, is the son of a Tennessee legend, the late Thomas H. Frist, physician to six governors and founder of the Hospital Corporation of America, now known as HCA. The future senator grew up in Nashville’s wine-sipping GOP precinct Belle Meade, an exclusive suburb, and went to school at the elite, all-boys Montgomery Bell Academy before heading off to Princeton and then to Harvard Medical School. He was a daredevil lad, speeding on motorcycles at 15 and making his first solo flight a year after that.

Though Frist invested from an early age in HCA stock-the basis of his multimillion-dollar fortune-he decided that he would never play a role in the company that his father and brother, Thomas Frist Jr., built into the largest chain of for-profit hospitals in the country. Instead, Frist threw himself with consuming intensity into becoming a transplant surgeon. In an episode that he now says he deeply regrets, Frist toured animal shelters around Boston, offering to care for stray cats that he then killed for medical experiments.

“Medical school,” he wrote, “was in the business of stripping human beings of everything but the raw, almost insane, ambition you must have simply to get through.”

Frist’s background was Southern, but not Deep South. Nashville was home to an established black middle class and a thriving Jewish community. By living in New Jersey, Boston and Northern California, Frist became a cosmopolitan member of the American wealthy elite. It suggesting that he may have more in common with the last majority leader from Tennessee-Howard Baker-than with the two more recent GOP leaders, hardscrabble Kansan Robert J. Dole or Lott, the son of a Pascagoula shipyard worker.

After his training, Frist returned to Nashville to practice at Vanderbilt University’s well-respected hospital-again avoiding the family chain. He specialized in transplant work, heart and lung replacements, sometimes flying his plane to retrieve an organ, then rushing it back for installation.

The distance he maintained from HCA probably saved his political life.

In the late 1980s, the Frist family company was swallowed in a hostile takeover, and Frist’s father and brother ceded management control to the owners of what became Columbia/HCA. In 1997, FBI raids on company hospitals turned up widespread Medicare fraud. According to attorneys for the whistleblowers who revealed the massive overbilling, HCA engaged in illegal practices even before the takeover. But Thomas Frist Jr. returned to the helm of the company as unpaid chairman and chief executive, and worked to restore trust in the company.

This week, HCA (the old name is back) announced that it would pay the federal government $631 million to settle fraud claims-bringing the total payments by the company to $1.7 billion.

When Frist challenged Sen. James Sasser (D-Tenn.) in 1994, he disclosed that $13 million of his $20 million in assets was in HCA stock. Much of his wealth, and that of his wife and three sons, is in limited blind trusts with a value of between $10 million and $35 million, according to his 2001 financial disclosure report.

But this distance from HCA has not entirely shielded Frist from attack. “With the health system in crisis, Republicans are considering a Senate majority leader who made his millions from a family-run company that defrauded Medicare, overstated expense statements, billed for services ineligible for reimbursements and paid kickbacks to physicians to encourage referrals to HCA facilities,” said Physicians for a National Health Program, which has clashed with Frist over health care issues.

Spending $3.7 million of his own money, Frist capitalized on the Republican tide of 1994 to crush Sasser by 14 percentage points. In the eight years since then, he has personified the Bush administration dream of conservatism with a friendly face. Frist is “part of the conservative core of the caucus,” a leading Republican said yesterday, “but stylistically he is cool; he has a different set of credentials and a more bipartisan, moderate demeanor than a lot of people with identical voting records.” Frist has voted with Lott, for example, more than 90 percent of the time.

Being the first physician elected to the Senate in more than 50 years is a big part of that. Republicans have played up his medical expertise, drawing credibility from Frist’s medical degree on such key issues as patients’ rights, Medicare and prescription drug benefits. “Dr. Bill Frist” is the preferred mode of address for Bush and Senate colleagues. Party leaders get dreamy-eyed when they picture the new majority leader saving a life on the Capitol grounds-as Frist has done a couple of times in the past eight years. (Once, he resuscitated a collapsed tourist; another time, he tended to the grievously wounded gunman who killed two Capitol police officers. )

Frist has basked in the attention. He appears regularly as a party spokesman on television. On one of his missionary trips to Africa-Frist is a devout Presbyterian-he toured AIDS-ravaged countries with rock star Bono. And his recent book on bioterrorism-billing him as “the Senate’s only doctor”-was a bestseller.

The publisher of Frist’s book confirmed yesterday that Eli Lilly and Co. helped boost the book by purchasing 5,000 copies, which the pharmaceutical giant distributed in 13 cities as part of an educational effort to help health care professionals deal with bioterrorism. Jed Lyons, president and CEO of Rowman & Littlefield, said the sales had resulted from the company’s marketing to corporations, and neither Frist nor his staff had had anything to do with the sale or were aware of it. Under Frist’s contract, Lyons said, all royalties go to two Tennessee charities designated by the senator. “Bill Frist is way too smart to risk his reputation by trying to make a special sales arrangement with corporations that could embarrass him,” Lyons said.

Nevertheless, Frist has close ties to Lilly, which has been a major contributor to his campaign and to the NRSC when he was chairman. Frist wrote a provision, enacted into law, that restricted the ability of plaintiffs to sue the company for injuries resulting from Thimerosal, a mercury-based preservative used in vaccines against childhood diseases. The Lilly provision was quietly woven into the legislation creating the Department of Homeland Security .

Even his political opponents say Frist has been an astute and willing negotiator on health care issues-though seldom willing, in the end, to stray far from his conservative views. Rich Tarplin, assistant secretary for legislation at the Department of Health and Human Services during the Clinton administration, recalled working with Frist on a law in 1997 that vastly strengthened the Food and Drug Administration’s regulation of tobacco. Tarplin said he was struck by Frist’s “ability to synthesize very, very complex subject matter”-a facility Frist demonstrated two years later when they worked together on highly charged legislation to revise the nation’s method of allotting human organs for transplants.

Frist has also worked to provide greater access to health care in impoverished communities-including programs to train minority doctors and nurses. A policy analyst called Frist “a Boy Scout in all the positive ways,” though a political consultant added that he can come across as “sickly sweet and condescending.”

Smooth demeanor, mixed with dependable conservatism, has helped to make Frist a favorite in the Bush administration. Though he volunteered in 1992 to support the first President Bush’s reelection campaign, Frist caught the attention of Team Bush when he was touted by then-Sen. Paul Coverdell (R-Ga.), the Bush liaison in the Senate. Coverdell’s death in 2000 left a hole in the campaign, and Frist stepped in. Soon after, he found himself co-chairing the GOP platform committee.

For a while, at least, his closeness to the White House may trouble more than help him. Senate insiders predict he will be watched closely by GOP senators who resent a president trying to tell them-directly or indirectly-what to do. Democrats likely will dare him to stand up to Bush whenever they see a chance.

In one recent example, several Democrats chastised Frist for failing to get the $500 million he said was needed to fight AIDS in Africa. After initial promises, the White House cut the funding dramatically, then restored it in phases, then killed it in a larger fight over spending. Frist has said he still hopes to get the money.

Almost since his arrival in Washington, people have wondered how high the doctor would rise. Lott told friends several years ago that Frist was a likely successor. Others believe he has his sights on the White House in 2008. By stepping up to the current crisis, Frist has turned such speculation into a stern test. It has been said that politics isn’t brain surgery-but it isn’t heart surgery, either.

Staff writers Amy Goldstein and Dan Morgan contributed to this report.

© 2002 The Washington Post Company

http://www.washingtonpost.com/wp-dyn/articles/A20079-2002Dec20.html

Uwe Reinhardt responds on Malaysia’s single payer proposal

Capitalist Taiwan (the Republic of China) has had such a single-payer scheme since 1995. Malaysia may well be inspired by that system.

Oddly enough, the Communist Peoples Republic of China on the mainland has a basically capitalist health system with millions of uninsured, among them all children. Employed persons in urban settings are covered by a form of social insurance system, but not their children. There’s virtually no insurance coverage in rural areas. Finally, there’s not much of a safety net. Hospitals are not set up to give charity care. There’s no one to shift costs to.

Happy holidays,

Uwe Reinhardt

Theodore Marmor comments on Malaysia and Canada

Don, We have a lot to learn from Malaysian doctors. I hope this gets into a letter to the editor of The NY Times or The Post or somewhere.

Also, I might add that the discussion of health finance and the principles of distribution would be advanced if more American policy makers read through the Kirby and Romanow Reports on Canada’s Medicare. Both review what Medicare is meant to do, where strain has arisen, and why neither wanted to change the fundamental structure. They were meant to disagree some, but in the end the similarities are striking. And the premises are worth bringing into the US discussion directly.

Ted Marmor

Comment: Professor Marmor is right. Start writing those letters and opinion
articles now, and contact your legislative representatives ASAP.

Romanow Report:
http://www.healthcarecommission.ca/

Kirby Report:
http://www.parl.gc.ca/37/2/parlbus/commbus/senate/com-e/soci-e/rep-e/repoct02vol6-e.htm

Malaysian Medical Association support of universal government insurance:
http://www.emedia.com.my/Current_News/NST/Monday/National/20021223073302/Article/

Single payer proposed for Malaysia

New Straits Times
December 22, 2002
MMA seeks health cover for all
By Pritam Singh

Kuantan, Dec 22: The Malaysian Medical Association (MMA) has proposed to the Government the setting up of a national health financing scheme that will provide coverage for all citizens.

MMA president Datuk Dr N. Athimulam said under the proposal, already presented to Prime Minister Datuk Seri Dr Mahathir Mohamad, the young would subsidise the old, and the rich would subsidise the poor.

“The MMA feels any insurance scheme should be owned and run by the Government, and operated as a non-profit entity,” said Dr Athimulam at the 20th annual installation dinner of the MMA’s Pahang branch here last night.

Dr. Athimulam said insurance schemes run by private companies were profit-oriented and were only willing to insure the healthy.

“The private sector should not compete with the scheme, but complement it, and the Government should be the single payer of medical expenses.”

http://www.emedia.com.my/Current_News/NST/Monday/National/20021223073302/Article/

Comment: If only the leadership in the United States would abandon their third world” approaches to health care and follow Malaysia’s lead in advocating for a civilized health care system.

California HCOP – more than just another study

The Modesto Bee
December 22, 2002
Bridging insured-uninsured gap becomes fiery health care battle
By Jim Sanders

(California State Senators Sheila Kuehl and Jackie Speier) each are preparing legislation for universal health care, but their approaches differ significantly in style, financing and scope.

Kuehl is pushing for a complete overhaul – a “single payer” system – in which the state would replace insurance companies in collecting monies, contracting for medical services, and paying doctors and hospitals for services rendered.

Kuehl contends that the program would not cost more than is now spent statewide for health care. Conceptually, the program would rely on various taxes, not insurance premiums. Expansion could be supported partly from savings in administrative costs and through bulk purchasing, she said.

Doctors would have wide latitude to determine appropriate care under Kuehl’s proposal. The managed-care system would be replaced by one that relies on medical experts, under the auspices of an elected state health commissioner.

By contrast, Speier wants to build on the existing system, leaving private insurance in place but filling the gaps.

Speier proposes a “play-or-pay” system, Senate Bill 2, that would require employers to provide medical benefits or pay taxes toward creation of a publicly subsidized plan, Healthy California, to provide basic benefits to those lacking insurance.

The California Labor Federation also is developing a “play-or-pay” proposal that would reduce the ranks of the medically uninsured while retaining health care as a central element of collective bargaining.

Sen. Sheila Kuehl:

“Where we used to talk about whether we should attempt universal health care, the argument seems to have shifted to how we can accomplish it.”

http://www.modbee.com/local/story/5679831p-6653530c.html

Comment: Fortunately, the California Health Care Options Project was not just one more study of reform to be filed away, having no more impact than a footnote in future treatises on failed efforts at reform. The findings of the study are now being translated into legislation that actually offers real hope of reform.

Most of the major hurdles are still ahead, but at least we’ve broken from the starting gate. Let’s begin with the assumption that we will have universal health care, and let’s direct our efforts to identifying and adopting policies that are in the best interests of patients. That way, we’ll all be winners.

California Health Care Options Project:
http://www.healthcareoptions.ca.gov/

Dan Hodges dissents from Morone's proposal

I’m glad to see James A. Morone’s proposal has put single payer back in the national debate.

As you say, a value added tax and an employer option for supplementary insurance, could be considered “details” that might divert attention of “some single payer advocates.” However, I believe that every single payer advocate should find the provision of “automatic coverage for all legal residents of every age” a deal breaker.

Those of us who are single payer advocates in California will remember the very bad repercussions in 1994 (and into the following years) because Prop. 186 didn’t provide coverage to the undocumented.

We know from studies that the savings single payer achieves can fund high quality health care for all. Drawing on the findings for the single payer proposals in the state’s Health Care Options Project, for example, Senator Sheila Kuehl is committed to a single payer bill that will provide coverage to all California residents.

I hope in the future you can use the message of the day to raise a discussion about real universal coverage with single payer versus the kind proposed by Mornoe.

Dan Hodges

Dan Hodges dissents from Morone’s proposal

I’m glad to see James A. Morone’s proposal has put single payer back in the national debate.

As you say, a value added tax and an employer option for supplementary insurance, could be considered “details” that might divert attention of “some single payer advocates.” However, I believe that every single payer advocate should find the provision of “automatic coverage for all legal residents of every age” a deal breaker.

Those of us who are single payer advocates in California will remember the very bad repercussions in 1994 (and into the following years) because Prop. 186 didn’t provide coverage to the undocumented.

We know from studies that the savings single payer achieves can fund high quality health care for all. Drawing on the findings for the single payer proposals in the state’s Health Care Options Project, for example, Senator Sheila Kuehl is committed to a single payer bill that will provide coverage to all California residents.

I hope in the future you can use the message of the day to raise a discussion about real universal coverage with single payer versus the kind proposed by Mornoe.

Dan Hodges

Erosion of the social contract

Health Affairs
November/December 2002
How And Why The Health Insurance System Will Collapse
By Humphrey Taylor, Chairman of the Harris Poll

Abstract

The advocates of defined-contribution health plans extol the virtues of consumer-driven health care, consumer choice, and empowered consumers as solutions to the problems–particularly the rapidly growing costs–of employer-sponsored health benefits. This paper argues that the widespread use of defined contribution plans, with more consumer choice and more knowledgeable consumers, will lead to the erosion of the social contract on which health insurance must be based, with healthier employees subsidizing the care of older and sicker ones, and a death spiral of adverse selection. If unchecked by government intervention, these trends will lead to the collapse of employer-sponsored health insurance.

http://www.healthaffairs.org/1130_abstract_c.php?ID=http://www.healthaffairs.org/Library/v21n6/s28.pdf

Sen. Bill Frist and Medicare

Comment on Sen. Bill Frist and Medicare:

In the recent election, Sen. Frist counseled the Republican candidates to support prescription coverage for senior citizens but without providing any of the specifics of their proposal. The Republicans will now have to deliver on that promise even if their proposal will be inadequately funded, and will primarily benefit pharmacy benefit managers, private insurers and pharmaceutical firms, while providing little benefit for patients.

Most agree that give-back legislation will be important to prevent the exodus of providers from the Medicare program. But the Republican insistence on budget-neutral adjustments does not bode well for maintaining the fiscal integrity of the Medicare program. This is more bad news for Medicare patients.

Sen. Frist strongly supports Medicare privatization through the Breaux-Thomas-Frist premium support proposal. Regardless of their “marketplace competition” rhetoric, the real purpose of shifting from the public program to private plans is to reduce public costs by allowing “more affordable” private plans that shift more costs to patients, while simultaneously supporting the private, middleman health plan industry.

Republicans will continue to block prescription coverage through the traditional Medicare program, authorizing only a separate benefit by private insurers. By doing so, Medicare beneficiaries will be incentivized to exit the public program and enroll in private plans.

If these issues are addressed individually, the Democrats can muster enough support by exposing the nefarious policies behind each issue. It is much more likely that Sen. Frist will orchestrate a plan to present an omnibus bill that “provides prescription coverage, controls Medicare costs by modernizing the program, and assures the viability of providers by reducing some of the scheduled cuts in funding.” Superficially, the package may have broad appeal and gain the support of conservative Democrats that barely survived the last election. These Senators would have little to lose and some to gain by supporting a package that may look good to voters and that really doesn’t cost much at a time when more tax cuts are on the agenda.

Sen. Frist, by “saving Medicare,” will further his personal ambition to assume the number two spot on the 2004 ticket as a step toward the number one spot in 2008.

Although enacting comprehensive reform will be impossible in the next two
years, it will be imperative that we make every effort to:

(1) Protect Medicare as a program of social insurance by opposing privatization efforts,
(2) Fight for a prescription benefit that is incorporated into Medicare’s program of social insurance, and
(3) Assure that adequate give-back provisions are passed that do not parasitize some sectors of Medicare providers for the benefit of others.

Please accept my apologies for this blatantly partisan commentary. But only the Republicans have it in their power to save Medicare through a bipartisan effort that supports the Democratic positions on these issues.

Don McCanne

Single payer, Medicare for All option added to ESRI proposals

Economic and Social Research Institute
November 2002
Covering America: Real Remedies for the Uninsured
Volume II

Medicare for All

James A. Morone has proposed a single-payer approach to provide universal coverage with the following elements:

* The Medicare program with expanded benefits, including no cost sharing, would provide automatic coverage for all legal residents of every age.
* Funding would come solely from revenues raised by a new federal value-added tax.
* States could opt out (for residents under age 65) by proposing a program that meets federal guidelines and by paying 25 percent of the cost.
* Employers could offer coverage for additional benefits, with the employer-paid premium not subject to income tax.

http://www.esresearch.org/newsletter/booktwo/CovAm2.htm

Comment: Three new proposals for comprehensive health care reform have been added to the ten proposals presented last year by the Economic and Social Research Institute. Of great significance is the fact that this single payer, Medicare for All proposal has helped to place this concept back into the national debate over the various options for reform. This is another crucial breakthrough since the single payer option has often been explicitly excluded from the forums on reform (as it was in the ESRI report last year).

Some single payer advocates might be concerned about a few of the features of Professor Morone’s proposal, such as the value added tax (VAT) and an employer option for supplementary insurance. He ameliorates, to some degree, the regressive nature of the VAT by exempting food, medicine and shelter, and by expanding the earned income credit to families with incomes up to $45,000. Also he limits the employer supplement to extra benefits such as hospital amenities.

But rather than diverting attention to various details of his proposal, we should direct our efforts to being certain that the fundamental single payer message is included in all forums, discussions and deliberations. America can only benefit by making health care reform a fully informed process.